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National Environmental Health Action Plans (NEHAPs)

Objectives

NEHAPs represent comprehensive, holistic and intersectoral way of planning and implementing environmental health action at the national level. NEHAPs are not only plans but in many cases have turned into national processes for environmental health.

Methods

NEHAP is a process of developing, adopting, implementing and evaluating environmental healt h policy. Therefore, different methods are used during the different phases. The preparation phase requires participatory assessment of environmental health situations, priority setting, cost -benefit analysis, public participation, and interdepartmental consultation. The adoption usually is linked to different communication techniques. The implementation phase may include risk perception studies, environmental health impact assessment, public information, consultation, and participation, and other risk management techniques, along with adoption of laws and regulations, preparation and management of research and development projects, institutional building, and training of trainers. The evaluation requires visioning exercises, focus groups, in-depth personal interviews, content analysis of documents, public opinion studies, analysis of strengths, opportunities and constraints.

Elements of NEHAP

Environmental health situation analysis

Decision to develop NEHAP is made by the national government, usually the ministries of health and environment.

A working group is being established to prepare analysis of environmental health situation in the country.

The analysis usually covers the hazards in air, water, waste, food, and work place and their health effects

The analysis may also include chemicals, human settlements, certain economic sectors, as well as horizontal issues such as environmental health institutions, legislation, information systems and public participation.

Developing NEHAP

Priorities for environmental health actions are being set on the basis of the analysis, interdepartmental and public consultation. The ministries of health and the environment organize consultation with key stakeholders, such as business and industry, local authorities, non-governmental organizations, new media, and academia.

In some countries, the development process ends with a document a plan that has strategic orientation and doesn’t specify individual actions. In other countries the plans are developed further into action programme.

When actions are considered, the working group translates the established priorities into possible actions.

The actions, thus identified, are weighted in terms of their technical and economic feasibility.

Developing countries usually receive assistance from WHO or donor countries.

Adoption of NEHAP

The draft NEHAP is being circulated for comments to the other governmental departments

The final text is approved jointly by the ministers of health and the environment, or by the national government, or by the president. In some countries, NEHAPs are also endorsed by the parliament.

The adoption is accompanied by public relations activities, such as launching publicly the plan, press conferences and other events to increase public awareness.

Implementation of NEHAP

If NEHAP has been adopted in the form of strategy, it is necessary to develop one or several action programmes to implement it. This is done by the ministries of health and environment in consultation with other governmental departments.

Allocating necessary budget for implementation is crucial step in the implementation. The state budget may provide part of the funds needed for NEHAP implementation, if the government or the parliament has approved it. Otherwise, ministries of health and the environment allocate some portion of their budget for implementation of activities under NEHAP.

A steering committee is being composed to oversee NEHAP implementation. The ministries of health and the environment, representatives of other governmental departments and agencies, scientists, and representatives of the major stakeholders compose the committee.

The steering committee elaborates a detailed working plan with deadlines and responsible actors.

The implementation also includes the following areas of horizontal activities:

Strengthening environmental health in economic sectors, usually through environmental health impact assessment of development projects,

Development of environmental health information system,

Strengthening environmental health legislation and services,

Public information and participation,

Training of trainers and education of environmental health professionals.

Evaluation of NEHAP

The Steering committee decides on evaluation of NEHAP and defines the terms of reference of the evaluation.

Internal and external experts who have appropriate background and skills compose the evaluation team

The evaluation team develops plan and instruments for the evaluation

The evaluation usually includes:

Interviewing people who represent the major stakeholders in NEHAP development and implementation and who have been involved in the process,

Focus groups to discuss the strengths, weaknesses, opportunities and constraints of NEHAPs,

Review of documents related to NEHAP, such as national action plans on environment, national health programmes, and the strategies for sustainable development

Relevance to policy-making

NEHAPs are a particular way of policy making and management in the area of environmental health. NEHAPs have been developed as national follow up of the Environment and Health Action Plan for Europe, which was approved by the Second Ministerial Conference on Environment and Health, Helsinki 1994. By 2003, every four out of five Members States of the WHO European Region have developed NEHAPs, Some countries in other WHO regions, such as the Western Pacific have also developed NEHAPs. The process was also considered by the Second conference of the ministers of health and the environment of the Americas in 2002.

Examples 1: The impacts of NEHAP in the European region

The evaluation of the impact of developing and implementing NEHAPs in the ten pilot countries from the European regions revealed that:

NEHAP worked as a process bringing together environment, health and other governmental sectors on a common project,

NEHAP has put environmental health higher on the political agenda,

In Central and Eastern Europe NEHAP has stimulated the development of environmental health legislation and institutional building,

NEHAP has introduced new ways of intersectoral thinking and working,

NEHAP has little visibility or recognition beyond those who directly participated in it,

NEHAP was primarily a government sector activity often concentrated at the national level,

The intended impacts of NEHAPs would have happened anyway, but more slowly, and the direction of change would be somewhat different.

References

Perlstadt, H. (2003) International evaluation of the environment and health process and action plans in Europe: findings and lessons learned from the pilot phase, http://www.euro.who.int/envhealthpolicy/Policy/ Ivanov, I., H. Perlstadt (2002) Evaluation of the impacts of national plans on environment and health and the European environment and health process: methodology for pilot national evaluation , http://www.euro.who.int/envhealthpolicy/Policy/
WHO, Regional Office for Europe, (1995) Development of national environmental health action plans, Copenhagen
WHO, Regional Office for Europe, (1999) Implementing NEHAPs in partnership, Copenhagen
WHO, Regional Office for Europe, (2002) Support to NEHAP implementation in Central Europe and the Baltics: report from DEPA Project , Copenhagen
EEHC, Progress Made since London: Reports from 5-th, 6-th and 7-th meeting, http://eehc.dk